Reed Jr., Carl W. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Carl W Reed Jr Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/09/2019 85 Years War or Dates
l• Place of Death Hospital,Institution or
WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek
p Manner of Death Natural Cause Accident Homicide El Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
James Hindson MD
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed District Number Register Number
City,Town or Village North Creek 5655 49
Burial Date Cemetery,Crematory or Facility Name
12/11/2019 Plneview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation _
z Removal Date Place Removed
El and/or and/or Held
(= Hold Address
N
O
G. Date Point of
fAFlTransportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
Q
W
(' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/10/2019 Registrar of Vital Statistics Kathleen C.Lorah(Electronically Signed)
/signature)
District Number 5655 Place North Creek, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H C/✓ \
WDate of Disposition Z I I Place of Disposition (address) t
a
LU
N (section) (lot number/ (grave number)
IX t, L
GName of Sexton or Person in Charge of emises / easeprintl
W Z4 Title
Signature
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 3 13-1 4 3
Receipt
r,
Human remains of ,
delivered on ' ' , 20
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Pine View Cemetery - R senting the funeral home named on burial permit
Official Funeral Directors Reg.or License